Liver Stiffness Measurement Predicted Liver-related Events And All-cause Mortality:A Systematic Review And Nonlinear Dose-response Meta-analysis

PurposeThere have been many studies investigated the prognosis value of liver stiffness measurement(LSM)by transient elastography(TE)in assessing the risk of liver-related events(LREs)and all-cause mortality in patients with chronic liver disease(CLD).However,the shape of the dose-response relationship between them is still unclear.MethodsWe searched PubMed,Embase,and Cochrane Library,as well as reference lists of articles,for studies published up to July 1,2017 that assessed the LSM in predicting LREs and all-cause mortality among subjects with CLD.A total of 54 observational cohort studies with 35249 participants were included.Summary relative risks(RRs)were calculated using a random-effects model.Restricted cubic spline function was used to model the dose-response association.ResultsLREs and all-cause mortality were increased in subjects with high LSM,with a RR of 7.90(95%confidence interval(CI)=5.65-11.05,I2=71.6%)and 4.15(95%CI=2.56-6.72,I2=68.5%),respectively.For per unit increment of liver stiffness,the summary RR was 1.06(95%CI 1.06-1.07,I2 =74.6%)for LREs and 1.06(95%CI 1.04-1.07,I2 =55.7%)for all-cause mortality.A positive relationship with a nonlinear trend for LSM with LREs and all-cause mortality was examined by a dose-response meta-analysis(P<0.001).Specifically,when stratified by etiology,a nonlinear association was also found in HCV infected patients and HCV/HIV coinfected patients.In contrast,there was no evidence of departure from linearity among patients with HBV infection(P nonlinearity =0.072).ConclusionLSM is useful in screening LREs and all-cause mortality in patients with CLD.Further studies are warranted in assessing the application of LSM in monitoring the risk of LREs and all-cause mortality in clinical practice.